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Cited by 2,953Lipoproteins and Cardiovascular HealthInflammatory Biomarkers in Disease PrognosisAdipokines, Inflammation, and Metabolic Diseases

C-Reactive Protein and Other Circulating Markers of Inflammation in the Prediction of Coronary Heart Disease

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Danesh, John, Wheeler, Jeremy G., Hirschfield, Gideon M., Eda, Shinichi, Eiriksdottir, Gudny, Rumley, Ann, Lowe, Gordon D.O., Pepys, Mark B. +1 more·2004·New England Journal of Medicine
DOI 10.1056/nejmoa032804
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Abstract

BACKGROUND: C-reactive protein is an inflammatory marker believed to be of value in the prediction of coronary events. We report data from a large study of C-reactive protein and other circulating inflammatory markers, as well as updated meta-analyses, to evaluate their relevance to the prediction of coronary heart disease. METHODS: Measurements were made in samples obtained at base line from up to 2459 patients who had a nonfatal myocardial infarction or died of coronary heart disease during the study and from up to 3969 controls without a coronary heart disease event in the Reykjavik prospective study of 18,569 participants. Measurements were made in paired samples obtained an average of 12 years apart from 379 of these participants in order to quantify within-person fluctuations in inflammatory marker levels. RESULTS: The long-term stability of C-reactive protein values (within-person correlation coefficient, 0.59; 95 percent confidence interval, 0.52 to 0.66) was similar to that of both blood pressure and total serum cholesterol. After adjustment for base-line values for established risk factors, the odds ratio for coronary heart disease was 1.45 (95 percent confidence interval, 1.25 to 1.68) in a comparison of participants in the top third of the group with respect to base-line C-reactive protein values with those in the bottom third, and similar overall findings were observed in an updated meta-analysis involving a total of 7068 patients with coronary heart disease. By comparison, the odds ratios in the Reykjavik Study for coronary heart disease were somewhat weaker for the erythrocyte sedimentation rate (1.30; 95 percent confidence interval, 1.13 to 1.51) and the von Willebrand factor concentration (1.11; 95 percent confidence interval, 0.97 to 1.27) but generally stronger for established risk factors, such as an increased total cholesterol concentration (2.35; 95 percent confidence interval, 2.03 to 2.74) and cigarette smoking (1.87; 95 percent confidence interval, 1.62 to 2.16). CONCLUSIONS: C-reactive protein is a relatively moderate predictor of coronary heart disease. Recommendations regarding its use in predicting the likelihood of coronary heart disease may need to be reviewed.

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  • IL-6 and CRP are key indicators of disease risk in middle-age and older adulthood as they are prospectively associated with coronary heart disease, diabetes, disability, and all-cause mortality.

    “Biomarkers of systemic inflammation, including interleukin-6 (IL-6) and C-reactive protein (CRP) are key indicators of disease risk in middle-age and older adulthood as they are prospectively associated with coronary heart disease (17,18) as well as diabetes (19), disability (20), and all-cause mortality (21).”

    From Socioeconomic Status Interacts with Conscientiousness and Neuroticism to Predict Circulating Concentrations of Inflammatory Markers (2017) · cites this paper as [17]

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Authors
Danesh, J., Wheeler, J. G., Hirschfield, G. M., Eda, S., Eiriksdottir, G., Rumley, A., Lowe, G. D. O., Pepys, M. B., & Gudnason, V.
Affiliations
  • University of Cambridge (GB)
  • The Royal Free Hospital (GB)
  • Roche (Japan) (JP)
  • Glasgow Royal Infirmary (GB)
  • Icelandic Heart Association (IS)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2004-04
Volume
350
Issue
14
Pages
1387-1397
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa032804
OpenAlex
W2058709767
Cited by
2,953
References
37
Citations by year
2026: 39 · 2025: 38 · 2024: 66 · 2023: 43 · 2022: 65 · 2021: 79 · 2020: 102 · 2019: 79 · 2018: 97 · 2017: 99 · 2016: 113 · 2015: 121 · 2014: 144 · 2013: 122 · 2012: 170
FWCI
238.23
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Oncology › Inflammatory Biomarkers in Disease Prognosis
  • Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
Keywords
C-reactive protein, coronary artery disease, inflammation, circulating inflammatory markers, erythrocyte sedimentation rate, von Willebrand factor, myocardial infarction, cardiovascular risk prediction, within-person variability, total cholesterol, cigarette smoking, Reykjavik Study
MeSH terms
Aged, Blood Sedimentation, C-Reactive Protein, Coronary Disease, Female, Humans, Inflammation, Male, Middle Aged, Prospective Studies, Risk, Risk Factors, von Willebrand Factor, Meta-Analysis as Topic, Biomarkers, Odds Ratio, Case-Control Studies

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